Oregon Dental Insurance > Regence Life & Health Insurance Company > Dollar-Based Dental Plan
Individual Dollar-Based Dental Premium Rates
Monthly Premium
Per Member
Quarterly Premium
Per Member
Dental Only
Dental & Vision
Dental Only
Dental & Vision
Under Age 18
$39.22
$42.10
$117.66
$126.30
18 through 64
$49.08
$54.33
$147.24
$162.99
65 and over
$61.06
$68.06
$183.18
$204.18
You may enroll for Dental Only Coverage or Dental with Vision Coverage.
All members must be enrolled for the same coverage and preimum payment schedule
Rates expire 6/31/2011
Individual Dollar-Based Dental Benefits
$1,500 Annual Max
$1,250 Annual Max
$1,000 Annual Max
$750 Annual Max
Year 1
Year 2
Year 3
Year 4
Plan pays:
100% of the first $150 of care
80% of the next $500 of care
50% of the remaining care until annual benefit maximum is reached
Dental done your way
Individual Dollar-Based Dental puts you in control of your dental health dollars. The plan is dollar-based. This means you can use your coverage almost any way
you choose, with few exclusions and limitations. Each year you visit the dentist for an annual exam and cleaning, you’re rewarded with a benefit increase the following year.
You decide how to spend your benefit dollars.
This plan features:
No deductibles
No limitations or exclusions for covered services (orthodontia, teeth bleaching and veneers are not
covered services)
The ability to choose any dentist but save even more by using one of our network providers (find a network provider at regence.com)
Optional vision rider available
(reimburses up to $150 in vision services and/or hardware per member every two years)
Here’s how it works
Each year that you take advantage of an annual exam and cleaning, the benefit dollars available to you increase. The goal is to reach $1,500 in available benefits by year
four.
Every year the plan pays: 100% of the first $150 of care, 80% of the next $500 of care, and 50% of remaining care until you reach your annual maximum benefit.
There is a six-month waiting period
for all covered services on this plan.
Dollar Based Benefits
Percent covered
Benefit payment
Year 1
$0-$150*
100%
$150
$151-$650
80%
$400
$651-$1050
50%
$200
Maximum Policy Year Benefit
$750
Year 2
$0-$150
100%
$150
$151-$650
80%
$400
$650-$1550
50%
$450
Maximum Policy Year Benefit
$1,000
Year 3
$0-$150*
100%
$150
$151-$650
80%
$400
$651-$2050
50%
$700
Maximum Policy Year Benefit
$1,250
Year 4+
$0-$150*
100%
$150
$151-$650
80%
$400
$651-$2550
50%
$950
Maximum Policy Year Benefit
$1,500
Incentive: You control your benefit increase by receiving at least one cleaning and exam during the benefit year.
No deductibles
No limitations or exclusions for covered services, except orthodontia, theeth bleaching and veneers
Six month waiting period
Optional Vision Rider available: $150 in services and/or hardware every 24 months